Adoptive Family Application for Services

We are honored that you have chosen to work with Adoption & Beyond. Please include the following when submitting your application:

Family Photo

$200 Application Fee

Start only when you have time to finish the form. If you have any questions as you complete this application, please contact Steffany at 913-381-6919 Ext. 5. Adoption & Beyond will contact you via e-mail following review of your application.

NOTE:International Adoption- You must have the assistance of a Hague accredited international placing agency in order for Adoption & Beyond, Inc.to complete an international home study for your family.

NOTE:If you have ever completed any forms on our website (Information Request or Consultation Form), mark YES, you have submitted information to us before. This will save you time and prevent double entry of information. If you can't remember your password, that's OK, you can reset it.

We may be able to save you time by pre-filling the form with the information that you have previously entered.

The Primary and/or Secondary e-mail addresses listed in this section will be used when contacting you about your adoption, including but not limited to general announcements, agency news, local and/or national adoption related events and adoption policy changes.

Password must be at least 8 characters with at least one uppercase letter, one lowercase letter, and one number.

Encryption Code

When sending important documents via e-mail (exp. your home study report), we will try to send them encrypted with password protection. We would like for you to choose the encryption password to be used when opening these documents.

Note: Encryption password is Case Sensitive and it should be No Longer than 6 Characters and with No Spaces between the Characters.

Please WRITE DOWN and keep safe for future use.

Document Encryption Code*

How did you learn about our agency?

How did you hear about us?*

Referral Source Details

Family Photo

A close-up Family Photo with all members living in the household. If you do not have an electronic photo available, please mail a photo to our office- labeled with your name and contact information on the back of the photo.

Photo

Previous Home Study

Have you ever had a previous home study process started?*

YesNo

Who started the previous home study process?

Date home study process began

Date home study process was completed or terminated

Did the home study recommend your family and/or other adult members of the household?

YesNo

If No, please explain

If the home study process was terminated, what was the reason for terminating the process?

Criminal History

Federal and state law requires that prospective adoptive parent's complete criminal and child abuse back ground checks. If you have ever been charged, arrested and/or convicted of a crime, please indicate below the approximate dates and nature of record. A criminal record will not necessarily prevent you from adopting a child; however, being dishonest will. It is important that you fully inform us of any such factors in your back ground.

Has Ap 1 ever been arrested or convicted of a crime?*

YesNo*

If Yes, please explain*

*

Has Ap 2 ever been arrested or convicted of a crime?*

YesNo*

If Yes, please explain*

*

Has Ap 1 ever had a history or investigation of child abuse/neglect, sexual abuse or family/domestic violence?*

YesNo*

If Yes, please explain*

*

Has Ap 2 ever had a history or investigation of child abuse/neglect, sexual abuse or family/domestic violence?*

YesNo*

If Yes, please explain*

*

Health History

Has Ap 1 had any significant medical or mental health condition?*

YesNo*

If Yes, please provide details explaining your diagnosis, prognosis, treatment, life expectancy and its potential effect on your ability to parent a child.*

*

Has Ap 2 had any significant medical or mental health condition?*

YesNo*

If Yes, please provide details explaining your diagnosis, prognosis, treatment, life expectancy and its potential effect on your ability to parent a child.*

*

Financial Stability

Net Worth Positive?*

YesNo

In order to establish a families financial health we will assess the families current Net Worth. Total your assets and minus your liabilities to determine your net worth. Is your net worth positive?